Healthcare Provider Details

I. General information

NPI: 1326059965
Provider Name (Legal Business Name): EXPRESS MEDS RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 BOY SCOUT DR STE 201
FORT MYERS FL
33907-2144
US

IV. Provider business mailing address

PO BOX 9830
SALT LAKE CITY UT
84109-9830
US

V. Phone/Fax

Practice location:
  • Phone: 239-274-3269
  • Fax: 239-936-1761
Mailing address:
  • Phone: 801-716-4721
  • Fax: 801-716-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH22069
License Number StateFL

VIII. Authorized Official

Name: RICARDO LUACES
Title or Position: VP
Credential:
Phone: 239-936-1041